Evaluating Frailty and Obesity in World Trade Center General Responders Utilizing Measures of Physiologic and Metabolic Function

PROJECT SUMMARY The individuals who were involved in the rescue and recovery efforts (responders) of the World Trade Center (WTC) tragedy were exposed to a complex mixture of airborne pollutants, and the health impact has been profound. Health conditions found to be associated with the WTC exposure are continuing to evolve. Since we are now over two decades from the event, it is imperative to evaluate how WTC exposure may impact the aging process and age-related disorders. There is emerging evidence that 9/11 exposure has an effect on age-related health outcomes, including frailty. Frailty increases with age and is defined as a clinical syndrome characterized by a decrease in one’s reserve and ability to maintain homeostasis across organ systems, and it has been linked to poor health outcomes. A World Trade Center Clinical Frailty Index (WTC-CFI) was developed to study frailty in this unique population and has been associated with high WTC exposure. As this vulnerable population ages, it is therefore critical to prioritize interventions to reduce modifiable risk factors that are potentially on the path towards frailty. One such modifiable risk factor is obesity. Given more than 80% of responders are overweight or obese and an elevated BMI has been associated with frailty, this is an important area of study. Our proposal aims to expand the understanding of the role of obesity on the trajectory of frailty and to determine the differences in objective physiologic and metabolic measurements in frail vs. non-frail obese responders to guide future evidence-based lifestyle interventions. We will achieve this with the following aims: 1) Determine the effect of obesity on frailty over time in the WTC GRC using the previously developed WTC CFI while controlling for other known, age-related risk factors; 2) Elucidate, for the first time, the role of obesity on frailty in a subset of frail and non-frail obese general responders from the Mount Sinai WTC Clinical Center of Excellence Healthy Steps for Older Adults (HSOA) intervention by comprehensively assessing differences in body composition, resting metabolic rate, substrate selection, serum biomarkers, dietary factors, and fitness measures to assess strength, aerobic capacity, and balance. Our proposal builds upon strong prior research and will be a crucial step in developing a greater understanding of both frailty and obesity and their complex relationship within this cohort that has already experienced a significant environmental exposure. Without this work, it would be challenging to create evidence-based lifestyle interventions for responders aimed at intervening on obesity as a modifying factor on the path towards frailty.